Employee’s Withholding Certificate

Step 1: Personal Information
W4 Form
Name*

First Name and Middle InitialLast Name
Social Security Number*
If your name does not match the name on social security card contact SSA
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status*

Single or Married filing separatelyMarried filing jointly or Qualifying widow(er)Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual)
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5.
Step 2: Multiple Jobs or Spouse Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.
Do only one of the following.

(2a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3 - 4); or

(2b) Use the Multiple Jobs Worksheet and enter the result in Step 4(c) below for roughly accurate withholding; or

(2c) If there are only two jobs total, you may check this box. Do the same on Form W-4 of the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld

TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
Step 3: Claim Dependents
If your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Multiply the number of qualifying children under age 17 by $2,000
Multiply the number of other dependents by $500
Add the amounts above and enter the total here
Step 4: Other Adjustments (optional)
(4a) Other income not from jobs:
(4b) Deductions:
(4c) Extra withholding:
Date and Sign
Date*

MonthDayYear
Employee's Signature*

Powered by Jotform SignClear
First Date of Employment

MonthDayYear
Step 2(b): Multiple Jobs Worksheet

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.
Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional tables; or, you can use the online withholding estimator at www.irs.gov/W4App.
1. Two jobs
2. Three jobs:

If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.
2a
2b
2c
3. Enter the number of pay periods per year for the highest paying job.
4. Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3.
Step 4(b): Deductions Worksheet
1. Enter an estimate of your 2021 itemized deductions
2. Enter:
3. If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater than line 1, enter “-0-” .
4. Enter an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Part II of Schedule 1 (Form 1040)).
See Pub. 505 for more information.
5. Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4.
Should be Empty:

Step 1: Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Dependents

Step 4: Other Adjustments (optional)

Date and Sign

Step 2(b): Multiple Jobs Worksheet

Step 4(b): Deductions Worksheet